Provider Demographics
NPI:1942598057
Name:CZARNIK, SCOTT D (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:CZARNIK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12735 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2442
Mailing Address - Country:US
Mailing Address - Phone:262-783-7302
Mailing Address - Fax:262-783-7513
Practice Address - Street 1:12735 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2442
Practice Address - Country:US
Practice Address - Phone:262-783-7302
Practice Address - Fax:262-783-7513
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist